Terms Used In Arizona Laws > Title 20 > Chapter 31 - Step Therapy

• Clinical practice guidelines: means a systematically developed statement to assist health care providers and patients in making decisions about appropriate health care for specific clinical circumstances and conditions. See Arizona Laws 20-3651
• Clinical review criteria: means the written screening procedures, decision abstracts, clinical protocols and practice guidelines that are used by a health care insurer, pharmacy benefit manager or utilization review agent to determine the medical necessity and appropriateness of health care services. See Arizona Laws 20-3651
• Control: means :

  (a) The power to vote, directly or indirectly, at least twenty-five percent of the outstanding voting shares or voting interests of a licensee or person in control of a licensee. See Arizona Laws 6-1201

• department: means the department of insurance and financial institutions. See Arizona Laws 20-101
• Exigent circumstance: means the action of a health care insurer, pharmacy benefit manager or utilization review agent on a step therapy protocol exception request within the application of the time periods for making a nonexpedited decision, as determined and documented by the prescribing provider, could seriously jeopardize the insured's, enrollee's or subscriber's life, health or ability to regain maximum function or cause a significant negative change in the patient's medical condition. See Arizona Laws 20-3651
• Financial institution: means banks, trust companies, savings and loan associations, credit unions, consumer lenders, international banking facilities and financial institution holding companies under the jurisdiction of the department. See Arizona Laws 6-101
• Germane: On the subject of the pending bill or other business; a strict standard of relevance.
• Health care plan: means a policy, contract or evidence of coverage that a health care insurer issues to an insured, enrollee or subscriber. See Arizona Laws 20-3651
• Individual: means a natural person. See Arizona Laws 6-1201
• Licensee: means a person licensed under this article. See Arizona Laws 6-1201
• Material litigation: means litigation that, according to United States generally accepted accounting principles, is significant to a person's financial health and would be required to be disclosed in the person's annual audited financial statements, report to shareholders or similar records. See Arizona Laws 6-1201
• Medically necessary: means , with respect to a prescription drug, appropriate under the applicable standard of care:

  (a) To improve or preserve health, life or function. See Arizona Laws 20-3651

• Methodologist: means a person that manages research design for the purpose of accurate and unbiased data collection and that has experience testing questions that are germane to the subject of the research. See Arizona Laws 20-3651
• Person: means any individual, general partnership, limited partnership, limited liability company, corporation, trust, association, joint stock corporation or other corporate entity identified by the director. See Arizona Laws 6-1201
• Pharmaceutical sample: means a unit of a prescription drug that is not intended to be sold but is intended to promote the sale of the prescription drug. See Arizona Laws 20-3651
• Step therapy exception: means a step therapy protocol that is overridden in favor of immediate coverage of a health care provider's selected prescription drug. See Arizona Laws 20-3651
• Step therapy protocol: means a protocol or program that establishes the specific sequence in which prescription drugs that are for a specified medical condition and that are medically necessary for a particular patient are covered by a health care insurer under a health care plan. See Arizona Laws 20-3651
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.